<extend name="en_us:Public:base" />
<block name="title">
    <title>Free to apply for QRInn account number</title>
</block>
<block name="extendHead">
    <link rel="stylesheet" type="text/css" href="/Public/dist/Home/common_public.css?rev=e43874d3c659fd13095708f1eee38b7d">
    <link rel="stylesheet" type="text/css" href="/Public/dist/Home/PublicPage/apply.css?rev=3a1db398fdfa2cd87d558ce1ea375d5d">
</block>
<block name="document">
    <div id="doc" class="container-above-md">
        <include file="en_us:Public:Include_public_header" />
        <div id="doc-body" style="padding-bottom:201px ;padding-top:30px ;">
            <div class="row md-width" id="main-form-container-wrapper">
                <div id="main-form-container" class="content-panel">
                    <div class="content-panel-header">Free to apply for QRInn account number</div>
                    <div class="content-panel-body">
                        <form class="form-horizontal">
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Hotel name:</label>
                                <div class="col-xs-9">
                                    <input type="text" data-tip-object="#apply-tip" maxlength="20" class="form-control" id="hotel" autocomplete="off" placeholder="Please enter the name of the hotel" value="" />
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Address:</label>
                                <div class="col-xs-9">
                                    <input type="text" data-tip-object="#apply-tip" maxlength="20" class="form-control" id="address" autocomplete="off" placeholder="Please input the hotel address" value="" />
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Hotel time zone:</label>
                                <div class="col-xs-9">
                                    <select class="form-control" id="addRequestUniversalTime">
                                        <volist name="universalTimeList" id="universalTime">
                                        <if condition="$universalTime['universalTimeId'] eq 5">
                                            <option value="{$universalTime.universalTimeId}" data-areacode="{$universalTime.areaCode}" data-countryid="{$universalTime.countryId}" selected="selected">({$universalTime.universalTimeUtc}){$universalTime.universalTimeName}</option>
                                        <else />
                                            <option value="{$universalTime.universalTimeId}" data-areacode="{$universalTime.areaCode}" data-countryid="{$universalTime.countryId}">({$universalTime.universalTimeUtc}){$universalTime.universalTimeName}</option>
                                        </if>
                                        </volist>
                                    </select>
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Currency:</label>
                                <div class="col-xs-9">
                                    <select class="form-control" id="addRequestMultiCurrency">
                                        <volist name="currencyInfo" id="currency">
                                            <option value="{$currency.id}">({$currency.standsymbol}) {$currency.name}/{$currency.usname} . {$currency.symbol}</option>
                                        </volist>
                                    </select>
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Province:</label>
                                <div class="col-xs-4">
                                    <select class="form-control" id="provinceContainer">
                                    </select>
                                </div>
                                <label class="col-xs-2 control-label">City:</label>
                                <div class="col-xs-3">
                                    <select class="form-control" id="cityContainer">
                                    </select>
                                </div>
                            </div>
                            <!--<div class="form-group">
                                <label class="col-xs-3 control-label">City:</label>
                                <div class="col-xs-9">
                                    <select class="form-control" id="cityContainer">
                                    </select>
                                </div>
                            </div>-->
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Province:</label>
                                <div class="col-xs-9">
                                    <select class="form-control" id="districtContainer">
                                    </select>
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Phone number:</label>
                                <div class="col-xs-9">
                                    <include file="en_us:Public:Include_area_code" style=''  />
                                    <input type="text" data-tip-object="#apply-tip" maxlength="11" class="form-control paddingArea" id="mobile" autocomplete="off" placeholder="Please input the phone no." value="" />
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Auth code:</label>
                                <div class="col-xs-6">
                                    <input type="text" data-tip-object="#apply-tip" maxlength="4" class="form-control" id="requestVerifiedCode" autocomplete="off" placeholder="Security code" value="" />
                                </div>
                                <div class="col-xs-3 input-group-right text-right">
                                    <img id="imgcode" onclick="javascript:refreshVcode();" src="{:U('/Home/Public/createpic');}">
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">Contact person:</label>
                                <div class="col-xs-9">
                                    <input type="text" data-tip-object="#apply-tip" maxlength="20" class="form-control" id="name" autocomplete="off" placeholder="Please input a contact name" value="" />
                                </div>
                            </div>
                            <div class="form-group">
                                <label class="col-xs-3 control-label">The source of the message:</label>
                                <div class="col-xs-9">
                                    <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="channel" value="option1" checked="checked"> Channel
                                    </label>
                                    <label class="radio-inline">
                                        <input type="radio" name="inlineRadioOptions" id="sales" value="option2">Clerk 
                                    </label>
                                </div>
                            </div>
                            <div class="form-group">
                                <div class="col-xs-3">
                                </div>
                                <div class="col-xs-9">
                                    <select class="form-control" id="select-channel">
                                        <option value="0">Please choose</option>
                                        <option value="1">Qrmaster</option>
                                        <option value="2">Qrclient</option>
                                        <option value="3">Baidu</option>
                                        <option value="4">Friend</option>
                                        <option value="5">Network</option>
                                        <option value="6">Market</option>
                                    </select>
                                    <input type="text" maxlength="20" class="form-control hidden" id="input-sales" autocomplete="off" placeholder="Please enter the name of the salesperson" value="" /> 
                                </div>
                            </div>
                            <div class="form-group form-tip-group has-warning">
                                <div id="apply-tip" class="help-block text-center">
                                </div>
                            </div>
                            <div class="form-group">
                                <button id="requestSubmit" type="submit" data-tip-object="#apply-tip" class="col-xs-4 col-xs-offset-4 btn-lg btn-primary btn-raised">Submit application</button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
        <include file="en_us:Public:Include_public_footer" />
    </div>
</block>
<block name="extendFootJs">
    <script type="text/javascript" src="/Public/dist/Home/common_public.js?rev=ad437de223cfea68cfa876e7e82721dd"></script>
    <script type="text/javascript" src="/Public/dist/Home/PublicPage/apply.js?rev=53262fcb31a1469bdc20979d0b825afd"></script>
</block>
